The XmnI locus, rs11886868, and rs766432 have a modifying effect on HbF and clinical score in HbE/β-thal patients in Indonesia, but not in β-thal patients.

Background: Although survival rates for retinoblastoma (RB) are over 95% in high-income countries, its high mortality rate in low and middle-income countries remains a great concern. Few studies investigated treatment outcome and factors contributing to RB survival in these latter settings. Aims of this study are to determine treatment outcome of Indonesian children diagnosed with RB and to explore factors predictive of treatment outcome. Methods: This study was a retrospective medical records review combined with an illustrative case report. Children newly diagnosed with RB between January 2011 and December 2016 at a tertiary care referral hospital in Indonesia were included. A home visit was conducted to perform an in-depth interview with a mother of two children affected by RB. Results: Of all 61 children with RB, 39% abandoned treatment, 21% died, 20% had progressive or relapsed disease and 20% event-free survival. Progressive or relapsed disease was more common in older (2 years at diagnosis, 29%) than young (<2 years at diagnosis, 0%) children (P=0.012). Event-free survival estimate at 5 years was higher in young (42%) than older (6%) children (P=0.045). Odds-ratio for event-free survival was 6.9 (95% CI: 1.747 -27.328, P=0.006) for young versus older children. Other clinical and socio-demographic characteristics had no significant correlation with treatment outcome or event-free survival. The case report elucidated conditions and obstacles that Indonesian families face when their children are diagnosed with RB. Conclusion: Survival of children with RB in Indonesia is much lower compared to high-income and many other low and middle-income countries. Abandonment of treatment is the most common cause of treatment failure. Older age at diagnosis is associated with more progressive or relapsed disease and worse survival. Interventions to improve general public and health-care providers' awareness, early detection and treatment adherence are required.

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Background: Starting from 2014, the Indonesian government has implemented Universal Health Coverage (UHC) with the aim to make healthcare services accessible and affordable to all Indonesian citizens. A major reason for childhood cancer treatment failure in low-and middle-income countries, particularly among families with low socioeconomic status (SES), is abandonment of expensive cancer treatment. Our study compared childhood cancer treatment outcomes of the overall, low, and high SES population before and after introduction of UHC at a large Indonesian academic hospital.Methods: Medical records of 1040 patients diagnosed with childhood cancer before (2011-2013, n = 506) and after (2014-2016, n = 534) introduction of UHC were abstracted retrospectively. Data on treatment outcome, SES, and health-insurance status at diagnosis were obtained.

Therapeutic platelet transfusions are often performed in pediatric patients with various indications. However, the platelet transfusion has potentially induced more harm than good for some patients. Therefore, its effectiveness needs to be evaluated. This study aimed to evaluate the clinical risk factors namely sepsis, splenomegaly, DIC (disseminated intravascular coagulation), severe bleeding and the history of platelet transfusion in the incidence of platelet refractoriness. This was a casecontrol study conducted over a 13-month period from August 1 st , 2010 until September 30 th , 2011 in Department of Pediatrics, Dr. Sardjito General Hospital, Yogyakarta. From a total of 1403 platelet transfusion episodes in 464 patients, 86 incidences of refractoriness and 86 of nonrefractoriness were observed. Bivariate analysis showed that sepsis [OR= 5.91 (2.90-12.05); p = 0.000], splenomegaly [OR= 2.82 (1.32-6.04); p = 0.006], severe bleeding [OR= 8.41 (4.19-16.871); p = 0.000], DIC [OR = 22.96 (6.73-78.35); p = 0.000] and the history of platelet transfusions [OR= 5.33 (2.78-10.23); p = 0.000] increased the risk of platelets refractoriness. Furthermore, multivariate analysis showed that sepsis (OR= 2.96; 95%CI: 1.19-7.32; p = 0.019), splenomegaly (OR=3.94; 95% CI: 2.21-16.00; p = 0.000), severe bleeding (OR = 3.53; 95% CI : 1.40-8.89; p = 0.008), DIC (OR = 5.54; 95% CI: 1.29-22.75; p = 0.021) and the history of platelet transfusion (OR = 2.84; 95% CI: 2.74-9.77; p = 0.001) were the independent risk factors for the occurrence of platelet refractoriness. In conclusion, sepsis, splenomegaly, severe bleeding, DIC, and the history of platelet transfusion are the risk factors of platelet refractoriness in pediatric patients.